Do Pancreatitis & cancer pancreas Cause Shoulder Pain?

Patients with acute pancreatitis may experience left shoulder pain. This type of pain is more common in patients with local complications of acute pancreatitis such as hemorrhage, collections, massive pancreatic necrosis, and damage to the nearby spleen.

In patients with pancreatic cancer, left shoulder pain is even less common. And it is often due to malignant spread to the cervical vertebrae or left shoulder bones.

1. What are the early warning signs of pancreatitis?

Your pancreas is a small organ in the upper left quadrant of your abdomen. It lies behind the spleen and the stomach.

The pancreas’s main function is to release digestive enzymes that digest different food components (protein, fat, and carbohydrate). It also helps regulate blood sugar (mainly through insulin secretion).

The inflammation of the pancreas can be either:

• Acute pancreatitis: sudden onset, severe, persistent pancreatic pain.
• Chronic pancreatitis: prolonged mild or recurrent inflammation may lead to the destruction of the pancreatic tissue and loss of its function.

Early warning symptoms and signs of pancreatitis:

• Sudden onset severe persistent pain in the upper central part of the abdomen (epigastric area.
• The pain often radiates to the upper back. In complicated cases, the pain may also radiate to the left shoulder.
• Sudden onset nausea.
• Sudden onset vomiting.
• Bloating and anorexia.
• In gallstone pancreatitis (a stone’s obstruction of the pancreatic and biliary duct), jaundice, dark urine, and clay stool may develop.

2. How common is shoulder pain with pancreatitis?

There is no data assessing the frequency of shoulder pain in patients with acute pancreatitis. However, shoulder pain appears when there is a severe/complicated form of the disease.

Shoulder pain occurs only when the phrenic nerve supplying the left diaphragm becomes irritated. And this often doesn’t occur unless pancreatitis becomes complicated.

Complications that are more likely to cause left shoulder pain with pancreatitis include (reference):

• Peripancreatic inflammatory collections.
• Hemorrhagic pancreatitis.
• Splenic affecting (abscess, splenic vein thrombosis, infarction) due to the spread of destructive digestive enzymes from the pancreas (Kehr’s sign).
• Large pancreatic pseudocyst.
• Walled-off pancreatic necrosis.

So, left shoulder pain in patients with acute pancreatitis may indicate severe pancreatitis. In addition, your doctor may need to re-assess the complications if the shoulder pain appears with pancreatitis.

3. Where is pancreatitis pain felt? And why does it affects the left shoulder?

Typically, pancreatic pain starts as sudden, severe, persistent pain in the upper central abdomen (epigastric area). Typically, the pain is confined to the epigastric area and radiates to the mid-back in 50% of the cases (reference).

Also, the pain commonly spreads to the upper left stomach area (the left hypochondrium). The pain often doesn’t come and go, but it may become partially relieved by sitting up or leaning forward.

Painless Pancreatitis!

Surprisingly, 5 to 10% of patients with severe acute pancreatitis may have painless diseases. Painless pancreatitis often occurs in critically ill patients, patients on dialysis, and patients with recent surgery (in the postoperative period).

In some cases, pancreatic pain may be felt in the left shoulder. This often occurs in complicated cases (hemorrhage, collections, or destruction of the surrounding organs due to pancreatitis).

It is unclear of the cases of painless pancreatitis can present with left shoulder pain without stomach pain or not.

Why pancreatitis causes left shoulder pain:

The local damage of tissues often irritates the left phrenic nerve (the nerve supplying the diaphragm). The phrenic nerve roots arise from the part of the vertebral column in the neck (cervical nerve roots C3, C4).

Another nerve group (the supraclavicular nerves) shares the same nerve roots with the phrenic nerve. These supraclavicular nerves are responsible for the pain sensation in the left shoulder.

So, irritation of the phrenic nerve may give rise to pain in the left shoulder due to the shared origin of these nerves (a classic example of referred pain).

The video below illustrates the idea of refereed pain: